Local Law Enforcement Trains on Tactical Casualty Care

In a day of training in Waldoboro Feb. 13, over 20 members from local law enforcement agencies learned how to help get medical care to those that need it in tactical situations.

Officers from Waldoboro Police Department, Lincoln County Sheriff’s Office, Damariscotta Police Department, and Boothbay Harbor Police Department attended the eight-hour course and trained on how to perform basic life-saving treatment and triage while under threat.

John Kooistra, one of the four instructors with Winslow-based Atlantic Partners EMS and a tactical paramedic with Portland Police Department’s Special Reaction Team, said the course is part of a nationwide training program developed by Denver, Colo. emergency medical services and special weapons and tactics, or SWAT, organizations and administered by the National Association of Emergency Medical Technicians.

In 2013 the NAEMT held five pilot programs of the course in Denver, and Atlantic Partners held the first three open courses in the country, Kooistra said. Subsequently, the program has taken off and is now offered nationwide, he said.

According to Kooistra, the training is largely directed at providing law enforcement with useful medicine for use in tactical environments such as a stand-off, a domestic violence situation, or an active shooter or killer situation.

Lincoln County Sheriff’s Deputy Jared Mitkus practices applying a dressing to a would-be armpit wound on Boothbay Harbor Police Reserve Officer Nick Upham. (D. Lobkowicz photo)

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Since the school shootings in Columbine, Colo. in 1999, law enforcement has been working toward a more active approach in dealing with tactical situations, Kooistra said.
As they were trained to do at that time, law enforcement responding to Columbine High School surrounded and contained the situation while they waited for SWAT teams to respond and clear the building of threats, he said.

The SWAT teams went through the large high school, evacuating uninjured people and leaving the wounded until they were able to clear the building of threats and bring in emergency medical services to treat those that remained, Kooistra said.

People died in the process due to the amount of time it took to clear the entire school and get the medical personnel in. Since then the trend has moved first to sending in four-officer teams to address the threat, and now even the first one or two officers are entering scenes, Kooistra said.

Though law enforcement’s focus remains on dealing with any threats, the tactical combat casualty care training provides a hierarchy for the officers to help get necessary medical care to those in need.

Law enforcement would then provide “force protection” for fire and EMS personnel to come into a specific, secured area to treat or extract the wounded, even while the large scene has not been cleared, Kooistra said.

If that is not possible, law enforcement would bring out the wounded to medical personnel for treatment, and if that is also not possible, the officers would provide basic life-saving treatment themselves, he said.

A level of trust is required for the force protection method to work, but law enforcement already provides force protection for other emergency responders in situations such as highway accidents, and responders accept that risk, Kooistra said.

“We already work in concert with law enforcement on this stuff, we just don’t realize we’re using force protection principles,” he said. “This is a ‘just in case’ layer of protection.”

Richard Lash, the director of Waldoboro EMS, said his department would support the police at a partially-cleared scene, but he would not force an employee to go into that situation.

EMS already faces dangerous situations when dealing with someone on drugs, during domestic disputes, and at homicides, and the technicians and paramedics work with those risks, Lash said.

“You’re always on alert because you just never know,” he said.

Under a time limit, Waldoboro police officers practice basic life-saving treatments. Sgt. Jamie Wilson (right) applies a tourniquet to the leg of Officer John Lash, as Officer Thomas Bartunek checks Lash for other wounds. (D. Lobkowicz photo)

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In the medical portion of the training, Kooistra said the officers are taught to focus first on hemorrhage control through the use of tourniquets on extremities and using direct pressure and “hemostatic agents” (products that help arrest bleeding) because a lot of people are lost to hemorrhagic wounds.

After those are addressed, the officers look to clearing obstructed airways, and recognizing if a person has a collapsed lung, he said.

“These skills are equally applicable to many situations they’ll come across” in the course of their normal duties, such as someone injuring themselves with a chainsaw, Kooistra said.

Along with classroom sessions, the officers went through practical stations where they learned to apply some of the skills, such as applying dressings and tourniquets.

One particularly realistic station included packing a “wounded” hunk of meat fed with fake blood through tubing. The officers would feel in the wound for the tubing – the source of the bleeding – and then fully pack the opening of the wound with gauze before applying body-weight pressure to help arrest the bleeding.

Using the meat helps the officers get the feel of working with actual tissue when packing a wound, said instructor Brian Chamberlain.

“These are all really basic skills, but they are perishable,” and so the officers need hands-on practice, Kooistra said.

Atlantic Partners provided the course at a cost of $100 per student, including a national certification in tactical casualty care, books, equipment, and the instructors’ time, according to Chamberlain.

The training was sponsored by Waldoboro Police Department and Waldoboro EMS, but funded through the Lincoln County Emergency Management Agency, Kooistra said.